First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a sur... more First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a surrogate for insulin-dependent diabetes mellitus incidence among 17-34-year-old US Navy enlisted personnel followed for 6,077,856 person-years. In the 15-year period, the overall incidence of insulin-dependent diabetes mellitus was 21.3 per 100,000 person-years. Incidence did not differ significantly by sex, but was higher for blacks than whites (28.4 vs. 20.2 per 100,000 person-years, respectively; p < 0.05). Incidence increased with age threefold for white men and fivefold for black men (p < 0.05) between the ages of 17-19 and 30-34 years.
Although most ultraviolet B (UVB) radiation is absorbed by stratospheric ozone, dense anthropogen... more Although most ultraviolet B (UVB) radiation is absorbed by stratospheric ozone, dense anthropogenic sulfate aerosols in the troposphere may further attenuate UVB in some regions. Mortality rates from colon and breast cancer tend to be much higher in areas with low levels of UVB radiation. These high rates may be due in part to inadequate cutaneous photosynthesis of vitamin D.
Abstract : This prospective study assessed the risk of occurrence of disease and injury in active... more Abstract : This prospective study assessed the risk of occurrence of disease and injury in active-duty enlisted Navy engineering personnel compared to the total Navy during two time periods, 1974-79 and 1980-83. All white male active-duty enlisted personnel in 10 Navy engineering occupations were identified from the NHRC Career History File for the two time periods. Hospitalizations were identified from the NHRC Medical History File and diagnoses were grouped into 15 disease and injury categories. Standardized Morbidity Ratios (SMRs) were calculated as a summary measure of risk to minimize the effects of differing age-distributions in the occupations under study. Significance testing was performed using the Poisson distribution. All Navy engineering occupations combined had about 20% higher risks for nervous system disorders (principally hearing loss), musculoskeletal disorders, and accidents. This excess was statistically significant, and a large proportion of this excess was contributed by one occupational group: Boiler Technicians. Other high risk occupations were Hull Maintenance Technicians, Enginemen, and Machinist's Mates. Results of this study indicate that improvements in Navy engineering environments should be primarily directed toward Boiler Technicians, who were the major contributor to excess disease and injury observed in Navy engineering personnel. Keywords: Occupational diseases, Health surveys, Military medicine.
Abstract : Leukemia is the fourth most commonly occurring cancer in the Navy and in the United St... more Abstract : Leukemia is the fourth most commonly occurring cancer in the Navy and in the United States general population between the ages of 15 to 34 years. Historical computerized military career records maintained at the Naval Health Research Center were used to determine person-years at risk (4,072,502 person- years) by demographic characteristics and occupation for active-duty Naval personnel during 1974-1984. Computerized inpatient medical records were searched for first hospitalizations for leukemia. Cases of leukemia (N = 102) are verified using pathology reports or Medical or Physical Evaluation Board findings. For comparisons, age-adjusted incidence rates and Standardized Incidence Ratios (SIRs) were calculated using rates for the U.S. population provided by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The overall age-adjusted incidence rate of leukemia in active-duty Naval personnel was found to be very close to that of the U.S. SEER population (6.0 versus 6.5 per 100,000 person-years). Leukemia cases occurred in a wide range of occupations with differing estimated exposures, implying that leukemia in the young active-duty enlisted Navy population is predominately determined before entrance into service. This finding is intriguing in the light of several studies showing an excess risk of leukemia associated with exposure to electromagnetic fields.
3078 Background: An inverse association was observed between serum 25-hydroxyvitamin D [25(OH)D] ... more 3078 Background: An inverse association was observed between serum 25-hydroxyvitamin D [25(OH)D] levels and risk of female breast cancer in four recent observational studies. However, the exact 25(OH)D serum levels associated with a specific level of reduction in breast cancer incidence are still imprecise. Methods: Data were combined from all studies that provided data on risk of breast cancer by quantile of serum 25(OH)D, using Review Manager (Copenhagen: Nordic Cochrane Centre, 2007). The analysis was performed according to published international standards for meta-analyses of data from observational studies. The number of individuals and person-years at risk in each quantile (generally quartiles or quintiles) of each study was determined, and a record was created for each individual from each study, with a study number identifying the study, a serial number for the individual, the median 25(OH)D concentration in the individual’s quantile in their study, and a code indicating whether the individual was a case or noncase. Records from the cohort studies were combined into an inclusive dataset in which individuals were divided into quintiles of 25(OH)D. There was an approximately equal number of individuals in each quintile. Measures of risk (incidence rates or odds ratios) were calculated for each quintile, providing an estimate of the pooled dose-response relationship. The procedure was performed separately for cohort and case-control studies. Results for each type of study, and all studies combined, were plotted and tested for goodness of fit to a classical dose-response curve. Results: A sigmoid dose-response gradient was observed between serum 25(OH)D and risk of breast cancer, and was approximately consistent across all studies. A higher serum 25(OH)D level (100-120 nmol/L) was associated with a projected 50% lower risk of breast cancer, compared to the serum 25(OH)D level associated in previous observational studies with 50% lower risk of colon cancer (80 nmol/L). Conclusions: Serum 25(OH)D is recognized as the optimal measure of vitamin D status. This study provides the most precise estimate available to date of the dose-response curve of the inverse association of 25(OH)D with risk of breast cancer, as estimated by observational studies. A substantially higher serum 25(OH)D level was needed for a projected reduction by half in incidence of breast cancer than for a similar reduction in risk of colon cancer, based on observational studies. The dose-response curve will help project the association of vitamin D deficiency states with risk of breast cancer, and will provide useful information for planning future clinical trials. Additional cohort and other epidemiological studies also would be worthwhile to further characterize this association.
Abstract : Melanoma is the second most common form of cancer after testicular cancer in males in ... more Abstract : Melanoma is the second most common form of cancer after testicular cancer in males in the US Navy. A wide range of occupations with varying exposures to sunlight and other possible etiologic agents occur within the Navy. In order to target possible preventive strategies this study was done to identify occupational groups which may be at excess risk of melanoma. One hundred seventy-six confirmed cases of melanoma were ascertained in active-duty white male enlisted Navy personnel during 1974-84. Individual occupations and occupations grouped by review of job descriptions into three categories of sunlight exposure: indoor, outdoor, or both were investigated.
First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a sur... more First hospitalizations (n = 1,293) for diabetes mellitus between 1974 and 1988 were used as a surrogate for insulin-dependent diabetes mellitus incidence among 17-34-year-old US Navy enlisted personnel followed for 6,077,856 person-years. In the 15-year period, the overall incidence of insulin-dependent diabetes mellitus was 21.3 per 100,000 person-years. Incidence did not differ significantly by sex, but was higher for blacks than whites (28.4 vs. 20.2 per 100,000 person-years, respectively; p < 0.05). Incidence increased with age threefold for white men and fivefold for black men (p < 0.05) between the ages of 17-19 and 30-34 years.
Although most ultraviolet B (UVB) radiation is absorbed by stratospheric ozone, dense anthropogen... more Although most ultraviolet B (UVB) radiation is absorbed by stratospheric ozone, dense anthropogenic sulfate aerosols in the troposphere may further attenuate UVB in some regions. Mortality rates from colon and breast cancer tend to be much higher in areas with low levels of UVB radiation. These high rates may be due in part to inadequate cutaneous photosynthesis of vitamin D.
Abstract : This prospective study assessed the risk of occurrence of disease and injury in active... more Abstract : This prospective study assessed the risk of occurrence of disease and injury in active-duty enlisted Navy engineering personnel compared to the total Navy during two time periods, 1974-79 and 1980-83. All white male active-duty enlisted personnel in 10 Navy engineering occupations were identified from the NHRC Career History File for the two time periods. Hospitalizations were identified from the NHRC Medical History File and diagnoses were grouped into 15 disease and injury categories. Standardized Morbidity Ratios (SMRs) were calculated as a summary measure of risk to minimize the effects of differing age-distributions in the occupations under study. Significance testing was performed using the Poisson distribution. All Navy engineering occupations combined had about 20% higher risks for nervous system disorders (principally hearing loss), musculoskeletal disorders, and accidents. This excess was statistically significant, and a large proportion of this excess was contributed by one occupational group: Boiler Technicians. Other high risk occupations were Hull Maintenance Technicians, Enginemen, and Machinist's Mates. Results of this study indicate that improvements in Navy engineering environments should be primarily directed toward Boiler Technicians, who were the major contributor to excess disease and injury observed in Navy engineering personnel. Keywords: Occupational diseases, Health surveys, Military medicine.
Abstract : Leukemia is the fourth most commonly occurring cancer in the Navy and in the United St... more Abstract : Leukemia is the fourth most commonly occurring cancer in the Navy and in the United States general population between the ages of 15 to 34 years. Historical computerized military career records maintained at the Naval Health Research Center were used to determine person-years at risk (4,072,502 person- years) by demographic characteristics and occupation for active-duty Naval personnel during 1974-1984. Computerized inpatient medical records were searched for first hospitalizations for leukemia. Cases of leukemia (N = 102) are verified using pathology reports or Medical or Physical Evaluation Board findings. For comparisons, age-adjusted incidence rates and Standardized Incidence Ratios (SIRs) were calculated using rates for the U.S. population provided by the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute. The overall age-adjusted incidence rate of leukemia in active-duty Naval personnel was found to be very close to that of the U.S. SEER population (6.0 versus 6.5 per 100,000 person-years). Leukemia cases occurred in a wide range of occupations with differing estimated exposures, implying that leukemia in the young active-duty enlisted Navy population is predominately determined before entrance into service. This finding is intriguing in the light of several studies showing an excess risk of leukemia associated with exposure to electromagnetic fields.
3078 Background: An inverse association was observed between serum 25-hydroxyvitamin D [25(OH)D] ... more 3078 Background: An inverse association was observed between serum 25-hydroxyvitamin D [25(OH)D] levels and risk of female breast cancer in four recent observational studies. However, the exact 25(OH)D serum levels associated with a specific level of reduction in breast cancer incidence are still imprecise. Methods: Data were combined from all studies that provided data on risk of breast cancer by quantile of serum 25(OH)D, using Review Manager (Copenhagen: Nordic Cochrane Centre, 2007). The analysis was performed according to published international standards for meta-analyses of data from observational studies. The number of individuals and person-years at risk in each quantile (generally quartiles or quintiles) of each study was determined, and a record was created for each individual from each study, with a study number identifying the study, a serial number for the individual, the median 25(OH)D concentration in the individual’s quantile in their study, and a code indicating whether the individual was a case or noncase. Records from the cohort studies were combined into an inclusive dataset in which individuals were divided into quintiles of 25(OH)D. There was an approximately equal number of individuals in each quintile. Measures of risk (incidence rates or odds ratios) were calculated for each quintile, providing an estimate of the pooled dose-response relationship. The procedure was performed separately for cohort and case-control studies. Results for each type of study, and all studies combined, were plotted and tested for goodness of fit to a classical dose-response curve. Results: A sigmoid dose-response gradient was observed between serum 25(OH)D and risk of breast cancer, and was approximately consistent across all studies. A higher serum 25(OH)D level (100-120 nmol/L) was associated with a projected 50% lower risk of breast cancer, compared to the serum 25(OH)D level associated in previous observational studies with 50% lower risk of colon cancer (80 nmol/L). Conclusions: Serum 25(OH)D is recognized as the optimal measure of vitamin D status. This study provides the most precise estimate available to date of the dose-response curve of the inverse association of 25(OH)D with risk of breast cancer, as estimated by observational studies. A substantially higher serum 25(OH)D level was needed for a projected reduction by half in incidence of breast cancer than for a similar reduction in risk of colon cancer, based on observational studies. The dose-response curve will help project the association of vitamin D deficiency states with risk of breast cancer, and will provide useful information for planning future clinical trials. Additional cohort and other epidemiological studies also would be worthwhile to further characterize this association.
Abstract : Melanoma is the second most common form of cancer after testicular cancer in males in ... more Abstract : Melanoma is the second most common form of cancer after testicular cancer in males in the US Navy. A wide range of occupations with varying exposures to sunlight and other possible etiologic agents occur within the Navy. In order to target possible preventive strategies this study was done to identify occupational groups which may be at excess risk of melanoma. One hundred seventy-six confirmed cases of melanoma were ascertained in active-duty white male enlisted Navy personnel during 1974-84. Individual occupations and occupations grouped by review of job descriptions into three categories of sunlight exposure: indoor, outdoor, or both were investigated.
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Papers by Edward Gorham